Psychosis

  • Basics

    Psychosis is a psychiatric condition that causes a person to lose his or her sense of reality. People with psychosis have hallucinations, delusions, or disorganized thinking that cause them to lose touch with reality. Someone who is psychotic may hear voices that no one else can hear, or perceive threats that are not real. Psychosis can be very disturbing when it happens to someone you know and care about. The person might not acknowledge that anything is wrong, and may resist efforts to help.

  • Causes

    An array of medical and psychiatric problems can cause psychosis Table 01. Psychosis can result from a variety of psychiatric and medical problems. When psychosis stems from a mental illness, it is best handled by a psychiatrist. However, a family doctor or neurologist can manage cases of psychosis that are triggered by an underlying medical problem.

    Drug and alcohol use and withdrawal have been linked to psychotic episodes. Symptoms that are drug— or alcohol—induced sometimes fade after the intoxicating effect of the substance has worn off.

    Physical illnesses that interfere with brain function may cause psychosis as well. Psychosis is associated with infections, brain tumors, metabolic abnormalities, nutritional deficiencies, and dementia.

    Psychiatric illnesses, most commonly schizophrenia, frequently lead to psychosis. Delusional disorder, marked by unshakable false beliefs, is another psychotic condition. Psychosis sometimes accompanies affective disorders such as depression and bipolar disorder (manic depression). In such cases, the symptoms tend to conform to the patient’s mood. For example, depressed patients may hear voices telling them to end their life. Bipolar patients in the throes of the illness’s extreme highs may believe they can fly or perform other superhuman feats.

    Finally, a stressful event — such as witnessing a violent act or being sexually abused — can produce psychotic symptoms.

    Table 1.  Possible Causes of Psychosis

    Cause Comments
    Drugs and alcohol The use or withdrawal of drugs and alcohol can cause intense visual hallucinations and confusion. Symptoms usually come on suddenly and may disappear once the intoxicating effect of the substance has worn off.
    Physical illness AIDS, encephalitis, brain tumors, dementia, metabolic problems, and nutritional deficiencies sometimes bring on visual hallucinations and fragmented delusions.
    Schizophrenic disorders Schizophrenia (psychotic behavior that lasts for at least 6 months) and schizophreniform disorder (psychotic behavior that lasts for less than 6 months) typically cause auditory hallucinations. Delusions tend to be well?formed and may be elaborate. The ability to socialize and function typically becomes impaired.
    Affective disorders Bipolar disorder and depression can have psychotic manifestations that reflect the patient?s mood: delusions of grandeur during mania and delusions of worthlessness during depression.
    Paranoid states Delusional disorders might make people who are otherwise mentally sound have false beliefs that are paranoid in nature. For example, patients may believe the FBI is watching them or that someone is out to get them.
    Reaction to severe stress Psychotic symptoms sometimes arise after a major life stress, such as a pregnancy or a death in the family. Postpartum psychosis usually occurs a month after giving birth. Being subjected to violence also can trigger psychosis.

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